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With the season changing, the days getting longer, more people are running and many will be training for the London Marathon in April. Some will have sensibly started the required training regime during the dark winter months, building up their stamina gradually and systematically. Others will have waited until the weather was more enticing thus leaving themselves a little less time for the body to adjust to the demands being made. Finally there will be those who start training just a few weeks before and realise they might have left it a bit too late. At whatever stage your clients come to you, it can be a challenge to get them through this event.

Janet’s Story Janet is coming up to her 50th birthday, although slim and long legged in stature, biomechanically she has limitations which originate from her feet. She is someone I would not actively encourage to run long distances simply because she lacks the support and absorption needed when making contact with the ground. But it is important that I consider her ultimate desire to run a marathon in her 50th year and rise to the challenge. It may not be the ideal situation, but this is what makes this profession interesting.

She has what is often referred to as flat feet. Although the arches are not completely collapsed, there is very little ability for the feet to absorb the impact generated from running due to almost non-existent or low arches. If the feet are not doing the job they were intended to do, which is to absorb the impact from the ground, the force is generated through the joints of the skeletal system rather than the muscles. As you can guess, it leads to joint injuries and pain. Janet originally came to me with symptoms of knee and lower back pain. This is typical of her condition.

If you do get someone who comes in displaying signs and symptoms of knee, hip and lower back pain, you might need to consider what is happening at the base, as it influences everything above. At this time I chose to do a full postural assessment and gait analysis. The assessment showed strong evidence her feet were a problem and needed support.

Recommendations were

1. A pair of running shoes with extra cushioning for absorption. Highly recommended are specialist running shops, as they have the knowledge and observation skills to fit people appropriately for the sport.

2. Professionally fitted orthotics (inserts for the shoes), specifically made for her.

3. Alternate the road running with the treadmill and include other disciplines to help build up her cardiovasular fitness.

4. Her training also needed to include non impact choices such as using the cross trainer, bike or swimming, to increase her endurance and stamina.

5. Janet needed to build up muscle strength and engage the underused muscles, such as gastrocnemius, soleus, and quads.

6. Stretching the tight and overused muscles such as the hip rotators. Muscle Energy Techniques and Soft Tissue Release, and Activated Isolated Stretching are examples of effective stretching techniques used.

It took her longer to build up to the level of fitness needed to do the distance on the road, and this had to be accounted for in the time scale of her training. She did the Marathon in less than 4 hours, which is excellent going for anyone never mind having to work through numerous challenges. Unfortunately she now has it in her mind that she wants to in the muscles and can do more marathons.

The Wild Card

Many new clients are unaware of the benefits of regular massage when training. The Wild Card is someone who has either not had massage or regular massage, but decides it would be a good thing to have the week before the event. They usually bring a list of "mild nigglies", which have been plaguing them for months, but they do not think they are that important and "run through them". From a remedial point of view, dealing with the "nigglies" could be a disaster, so it is inadvisable to give anything other than a general flush, leaving any remedial work for after the marathon.

The week before the marathon is when runners should be tapering down, having a week of active rest, so as to build up an abundance of energy in the muscles. If remedial work is commenced at this time, not only will the body go into healing mode, but in essence, the massage will rob the athlete of their energy reserves. It can be a challenge to find the balance between achieving a good flush, and taking it so far that the body is having to repair and recover. Keep in mind that it is much better to do less than to go too deep and do too much.

Here is a great opportunity to educate your client about the benefits of regular Sport & Remedial Massage in conjunction with training, hopefully without making them feel like they won’t make it to the end this marathon.

The First Timer

The primary focus of most Sport & Remedial Massage therapists is to keep our clients injury free. One of my athletes has shared some good training advice on how he stays injury free which is simple and effective. He uses massaged to gauge how his muscles are handling the hours of training, as well as keeping them flushed and finely tuned. Also, he trains just until he reaches his optimum level and then rests. The resting period is very important, it allows his muscles to continue the building process, giving them time before moving onto the next level of training. Beginners can be a bit misguided and believe they have to train until they drop and then they can rest, (for some, rest is not in their vocabulary). Training to a point of total exhaustion and then resting to recover has negative effects. This creates a situation wherein the tissue is struggling to repair, rather than building new tissue to support the level of training. In a recovery situation such as this, in which the tissue is having to deal with too much micro trauma, this can over time lead to injuries. Encourage your new runners to listen to their bodies telling them when to stop and how much they should be doing. Better to do less and stay injury free than to push it too far and be forced to pull back due to injury.

As a Sport & Remedial Massage therapist, we can wear many hats. One of these areas is addressing the psychology of the client. In circumstances such as the marathon, it is equally as important what we say during our massage sessions as what we do. When therapists find areas of tension, trauma, or imbalance, how we verbalise what we find can have a significant impact. Comments should be made in such a way that they have a positive effect. In other words, when you find tissue trauma, adhesions, or a problem developing, be careful not to emphasize, or focus disproportionately. It is alright to acknowledge what your hands are telling you about the person, but try to focus on the solution, ie "this is a bit tight" what stretches are you doing? This will create an awareness which is usually enough to prevent an injury, without hindering their training or diminishing their confidence. As in all therapies, it is equally important to recognise when something is beyond your remit and refer when appropriate.

Post Marathon Massage

It is a rewarding experience to do volunteer to work at events, but there is something extra special if you are planning to massage at the London Marathon. The atmosphere is inspiring, the stories are as varied as the people, and no one forgets their experience of that day. Post event massage usually consist of good basic strokes that flush the muscles in the legs, and sometimes around the shoulder area. It can last anywhere from 10 minutes to 20, any more than that is stressful on an area that is already stressed. If you are working with a charity, usually they will have someone from a medical team assessing each person for injury before they get to the massage area. Sometimes someone does slip through and you need to be aware of symptoms for hyper and hypothermia, heat exhaustion, heat stroke, & dehydration.

Muscle Cramps

During a post marathon massage, it is not unusual for a runner to suffer from cramps. This can be due to: fatigue, dehydration, electrolyte imbalance (calcium, potassium, magnesium), muscle strain and injury.

Treatment

1. Bring origin and insertion of muscle closer together.

2. Stretch

3. Direct pressure may also help.

4. Ice massage

5. Replace fluids and electrolytes

Most runners while having their massage post race say they will never do it again, but are glad they have done it. Then a week later they will start talking to you about the next one they are planning to do. It is a bit like giving birth, we soon forget the pain and just remember the joy.

Event Advice

Running shoes: keep a rotation of 3 pairs at different stages of wear, an older pair, medium wear, and a new set. There is a big difference in how the shoe functions between new and old. In order to adjust to the differences, it is best to break in the new ones, while you are still training with other shoes at different stages of wear.

Clothing: always make sure that they have already run long distances in their chosen outfit of the day. Do not wear anything new as chaffing is a big problem. It is usually from a bit of new gear that has been put aside for the special day and has not been tried and tested.

By Susan Findlay

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Author:Susan Findlay

Biography: Susan comes from a background in dance (22 years) and gymnastics in which she competed nationally in Canada. She originally trained as a Nurse in her home country and practiced for 7 years before coming over to England in 1993.

After a year in the NHS she retrained as a health and fitness instructor working with GPs and health centers. After years of teaching 20+ classes a week and running health programmes she wanted to integrate her medical, health and fitness background under one umbrella. Hence, she trained once more in Sport & Remedial Massage, incorportating her background into her treatments. She has a busy private practice in North London.

She has been teaching since 1998 at numerous colleges, as well as lecturing nationally and currently continues to do both.

As is expected from the evolutionary process, Susan founded the NLSSM from a desire to see other high quality centers offering a professional course in Sport & Remedial Massage. She is also on the council of GCMT (General Council for Massage Therapy) a

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